Diabetes education booklet

Introduction to diabetes

Approximately 1.4 million people in the UK have diabetes and it is suggested by Diabetes UK that there could be another one million people with diabetes and are unaware they have it. The majority of people with diabetes (85% - 90% will have Type 2 diabetes). The remainder will have Type 1 diabetes.

Diabetes Mellitus is a condition in which the amount of sugar in the blood is too high. When we eat a meal the starchy and sugary carbohydrates are changed into sugar (glucose ) during dijestion and this sugar then  passes into the bloodstream. When the pancreas senses that there is a rising level of glucose in the blood it secretes a hormone called insulin. Insulin changes glucose into energy which provides fuel for the body. Insulin is vital for life because without it, the glucose could not be changed into energy and the body could not function without energy. It is often said that insulin acts like a key – unlocking the cell to allow the energy in. Obviously, like a car, we only need a certain amount of energy to provide for the requirements of the body. If we eat more than we need this will be stored as fat.

Signs and symptoms of diabetes

·         Excessive thirst

·         Frequency in  passing of urine

·         Blurred vision

·         Loss of weight

·         Tiredness

·         Mood changes

·         Frequent infections e. boils, thrush etc

Types of diabetes

There are two main types of diabetes:

·         Type 1 ( used to be called insulin dependent ) affecting children and young adults mostly

·         Type 2 diabetes ( used to be called non insulin dependent ) is commoner in the over 40 year olds although children as young as sixteen and obese are alsodeveloping Type2 diabetes

 Main Aim of treatment

The main aim of treatment of both types of diabetes is to normalise blood glucose levels to protect against long term damage to the eyes, kidneys, nerves,

heart and all the blood vessels. Some experts call diabetes “a blood vessel disease”  because preventing narrowing of the blood vessels is key to preventing complications.

Type 1 diabetes

The exact cause of Type 1 diabetes is unknown but thought to be due to a viral infection or environmental factors. In type 1 diabetes there is total destruction of the cells in the pancreas  ( beta cells ) that produce the insulin. The onset of type1 diabetes is acute, because as stated earlier insulin changes glucose into energy but in the absence of insulin, glucose builds up in the blood and is not turned into energy. In an effort to overcome the lack of fuel for the normal functioning of the body, fats and proteins are broken down instead. This is why

patients are often underweight at diagnosis.

Once treatment with insulin is started the patient will begin to feel better quickly and will regain the lost weight.

Treatment for type1 diabetes

People with Type 1 diabetes will need injections of insulin for the rest of their lives. Insulin is destroyed by the gastric juices so cannot be taken in tablet form.

People with Type1 diabetes will need a minimum of two injections daily and often more. They will also need to eat a healthy diet and take regular exercise and do regular self blood glucose testing

If you have been diagnosed with Type 1 diabetes please ask your health professional for the special  section on “ Insulin Ttreatment” which will give you much more specific and detailed information.

Type 2 diabetes

Type 2 diabetes occurs when the pancreas secretes less insulin than normal or when the insulin secreted fails to work properly (called insulin resistance). People who are overweight are five times more likely to develop Type 2 diabetes and four out of five people with Type 2 diabetes are overweight. Excess weight increases your body’s own glucose production and thus your body’s need for insulin too. At the same time, this extra insulin increases fatty acids stores and further increases insulin resistance. It becomes a vicious circle.

Type 2 diabetes is particularly associated with central excess weight ( apple shaped rather than pear shaped). Health risks increase when waist circumference is greater than 37inches (94cms) in men and 31.5 inches (80cms ) in women. Reducing calorie intake if you are overweight will help your body use insulin better by reducing insulin resistance.

You will find a whole section of this book devoted to healthy eating, weight control and exercise.

Type 2diabetes has a gradual onset. You may not feel any symptoms beyond a little tiredness which is often mistakenly attributed to age and working hard. As Type2 diabetes progresses  you may become aware of some of the signs already mentioned or you may be diagnosed  whilst being investigated for something else. It is suggested by experts that most people have had Type2 diabetes for at least five years before diagnosis.

The following people are at an increased risk of developing Type2 diabetes:

• Family history of diabetes
• Asian or Afro-Caribean origin
• Women who have had gestational diabetes
• Obese people
• People who take little exercise
• Older age
• People on certain medications eg steroids, and some anti psychotic medications

Treatment for Type2 diabetes

People with Type2 diabetes will be encouraged to eat a healthy balanced  diet and take regular exercise. They will be treated with diet only for the first three months after diagnosis (unless their blood glucose is very high and they are losing weight). If diet and exercise alone does not control your blood glucose levels you may also need to take tablets.

Diabetes and Driving in UK

Having diabetes does not mean that you cannot drive as long as you doctor says you are safe to do so – this is usually when your diabetes becomes stable and controlled. You will however have to plan in advance before getting behind the wheel of your car if you are on certain tablets for your diabetes and/or taking insulin.

You must by law inform the Driver and Vehicle Licensing Agency (DVLA) if

• Your diabetes is treated with tablets or insulin
• If your treatment changes from tablets to insulin or if insulin is added to the tablets
• If there are changes in your health or condition that may affect your ability to drive safely
• If you are applying for a licence for the first time, you must answer YES to the question about diabetes.

People Treated with Insulin

After you have written to the DVLA informing them of your insulin treatment, you will be sent a form (called “Diabetic 1”), asking for more information and for the name and address of your GP/ Hospital Doctor. You will be asked to sign a consent form allowing the DVLA to contact the doctor directly for more specific information on your diabetes control, eyesight and general fitness to drive.

This does not mean that you will be refused a licence – it just ensures safety for you and other drivers. Please answer all questions fully and honestly.

People Treated with Tablets

After you have informed the DVLA that you have diabetes, they will send you a letter explaining your responsibility to re-notify them if you start having insulin or have “hypos” (low blood sugar), or if you develop any of the complications of diabetes which could affect your ability to drive.

They will not normally ask you any other questions at this stage and you will normally expect to keep your “till to” licence.

Diet alone Treated patients

No restrictions on driving and do not need to inform DVLA.

Restricted Licences

Insulin treated – a driving licence will be issued to you for one, two or three years if you are treated with insulin. Just before expiry date, you will receive a reminder to renew your licence and you will be asked to return your current licence. You will be sent another “Diabetic1” form to confirm your medical condition. Renewals of restricted licences are free.

Tablets or diet treated – usually issued with a “till to” licence. When you reach 70 years of age, you will be expected (like everyone else in UK) to renew it every one to three years. There is a charge for this renewal.

Provisional licences – applies to insulin treated only – need to be renewed every one, two or three years.

When renewing licences, it is always sensible to keep a copy of the old licence or to make a note of the driver number, before sending to the DVLA. The process takes between six – eight weeks unless there are complications.

If you drive a motorcycle the rules for informing the DVLA are the same as for a car.

Eyesight Problems

Obviously it is important to have good distance vision and good field of vision (what you can see side to side when looking straight ahead). There are various tests that an ophthalmologist can do to carry out to test these factors. Your licence may be revoked if you fail a field of vision test, but you can appeal against it. There are different types of field of vision tests, some people do better on one type versus another. The DVLA will accept the results of any approved type of test.

Large Goods Vehicles (LGV) and Passenger Carrying Vehicles (PCV)

In 1991 the titles of HGV (heavy goods vehicle) changed to LGV

                    And PSV (public services vehicles) changed to PCV.

People treated with diet alone or diet and tablets are normally allowed to hold LGV and PCV licences, provided they are otherwise in good health.

People treated on insulin are not allowed to hold these licences. If you currently hold such a licence and start using insulin you must inform the DVLA and stop driving the vehicle immediately.

In 1996, the regulation on larger vehicles was extended to include medium sized vehicles. Anyone passing their driving test after 31^st December 1996 will only be given a licence to drive vehicles up to 3.5 tonnes.

Vehicles weighing 3.5 tonnes – 7.5 tonnes (Category CI ) and mini buses (DI) are now treated as Group 2 vehicles – normally there is a complete ban on insulin users obtaining a group 2  licence. However some CI licence holders can now apply for a medical assessment and can regain ability to drive these vehicles whilst on insulin. Please write to the DVLA for more information.

Taxis

The law does not bar insulin users from driving taxis, provided they are less than nine seats. As local councils issue licences the policy may vary in different parts of the UK. Some taxi authorities issue blanket restrictions. Please contact Diabetes UK and DVLC for more information.

Diabetes in Pregnancy (Gestational Diabetes)

If you need to commence insulin in pregnancy, you should notify DVLA immediately.

You will normally be allowed to continue driving but are recommended to stop if your control becomes unstable or if you do not have good warning signs of hypoglycaemia. You should re notify the DVLA six weeks after delivery if you are still on insulin, as your licence will need to be reassessed.

If you have problems relating to your driving licence, please discuss it with your diabetes team, who will be able to advise you. DVLA wish to issue licences, not to take them away – you can help by giving as much information as possible.

DO NOT DRIVE IF

·         You have difficulty recognising early signs of hypoglycaemia  (Section   )

·         You have started on insulin and your diabetes is not yet controlled.

·         You have problems with eyesight not corrected by glasses

·         You have numbness or weakness in your feet caused by nerve damage or circulation (neuropathy or ischaemia)

·         You have been drinking alcohol.

Precautions before Driving

• Long journeys need careful planning, allowing for regular stops if you are on specific tablets for diabetes and insulin.

Normally it is wise to have something to eat every two to three and half hours if you are on insulin and not to miss meals and not to delay meals if you are on tablets and insulin.

•  Test your blood sugar before driving and regularly during a long drive or if at work before you drive home at the end of the day or shift.

• ·Always carry quick acting glucose and slow release carbohydrate in the car at all times if you are on insulin or specific diabetes tablets.

• Always carry identification on your person and in the car stating your name, how your diabetes is treated and the name of your GP.

At the first sign of Hypoglycaemia

·         Stop driving as soon as it is safe to do so

·         Remove ignition key and move into passenger seat.

·         Immediately take glucose tablets or sugarydrink (both may be required)

·         Follow this with slow release carbohydrate i.e sandwich, crisps, biscuits etc.

·         Wait for at least 15 – 20 minutes until you feel better, recheck blood if possible, if you do not feel better, take more glucose and biscuits and wait a further 15 minutes.

·       If you continue to feel unwell – call for help and do not drive – if considering using motorway emergency assistance, please remember you may be unsteady on your feet, so take extra glucose before walking.

Car Insurance

 The main potential danger of diabetes and driving is the possibility of having a hypoglycaemic episode which could impair your judgement and lead to an accident.

Since the Disability Discrimination Act came into effect at the end of 1996, insurers can only refuse cover if they have evidence of increased risk.

It is virtually important to inform your motor insurance that you have diabetes.

Your motor insurance may become invalid if

·         You fail to update them on changes to your treatment or physical condition

·         You fail to notify the DVLA as mentioned previously

·         You fail to comply with DVLA restrictions or recommendations

Diabetes UK Services   has an exclusive service that will search through a panel of insurers for the best quote,  - freephone 0800 731 7431.

Life Assurance / Insurance

Some people experience difficulty getting life cover. It is important that you declare your diabetes when applying for a new policy. Any life policy you hold at the time of diagnosis is unaffected.

Any difficulties ring Diabetes UK Careline 0845  120 2960

Or write to Diabetes UK Careline, 10, Parkway, London, NW1 7AA (operates a translation service also)

Travel Insurance

Many travel insurance policies exclude pre-existing medical conditions such as diabetes, you must check carefully if your policy includes or excludes diabetes.

Some insurance companies charge an extra £10 - £15 to include diabetes. It is worth having a letter to this effect from the insurers

Diabetes UK are continually expanding the service they offer. Please see relevant telephone lists at the back of this booklet.

Diabetes and Employment

An employer cannot by law refuse to employ you or dismiss you purely because you have diabetes, according to the Disability Discrimination Act (DDA1995).

Although most people with diabetes do not consider themselves to have a disability, diabetes is covered by the Act.

Certain professions are exempt from the DDA and can refuse to employ someone with diabetes, especially if they are treated with insulin, these include

·         Air line crew

·         Armed services

·         Off shore workers

·         Train drivers

·         Any work requiring LGV and PCV

·         Police force

However, if diabetes is diagnosed whilst in this employment, it may be possible to continue with some negotiable changes in your duties. 

Skin Pigmentations and Calcifications PowerPoint Presentation free Download

This "Skin Pigmentations and Calcifications" PowerPoint Presentation Includes

• Skin Pigments
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• Hypo pigmentation
• Addison’s disease
• Café Au Leit Pigmentation
• Neurofibromatosis
• Hyper-pigmented skin nodules
• Lack of pigmentation
• Vitiligo
• Ochronosis
• Haemosiderosis
• Haemachromatosis/Bronze diabetes
• Wilson’s disease
• Lipofuscins
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• Dystrophic calcification
• Metastatic calcification
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Kidney Disease of Diabetes

Each year in the United States, more than 50,000 people are diagnosed with end-stage renal disease (ESRD), a serious condition in which the kidneys fail to rid the body of wastes. ESRD is the final stage of a slow deterioration of the kidneys, a process known as nephropathy.

Diabetes is the most common cause of ESRD, resulting in about one-third of new ESRD cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and ESRD. Most people with diabetes do not develop nephropathy that is severe enough to cause ESRD. About 15 million people in the United States have diabetes, and about 50,000 people have ESRD as a result of diabetes

ESRD patients undergo either dialysis, which substitutes for some of the filtering functions of the kidneys, or transplantation to receive a healthy donor kidney. Most U.S. citizens who develop ESRD are eligible for federally funded care. In 1994, the Federal Government spent about $9.3 billion on care for patients with ESRD.

African Americans and Native Americans develop diabetes, nephropathy, and ESRD at rates higher than average. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to diabetic nephropathy factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood sugar increase the risk that a person with diabetes will progress to ESRD.

Primary Diagnoses (Causes) for ESRD (1991)

2.9 percent Interstitial Nephritis

2.9 percent Polycystic Kidney Disease

11.4 percent Glomerulonephritis

18.1 percent Other Causes

28.8 percent High Blood Pressure

35.9 percent Diabetes

Two Types of Diabetes

In diabetes--also called diabetes mellitus, or DM - the body does not properly process and use certain foods, especially carbohydrates. The human body normally converts carbohydrates to glucose, the simple sugar that is the main source of energy for the body’s cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body is unable to use the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood or urine lead to a diagnosis of diabetes.

TYPE II DIABETES

Most people with diabetes have a form known as non insulin-dependent diabetes or Type II diabetes. Many people with Type II Diabetes do not respond normally to their own or to injected insulin a condition called insulin resistance. TYPE II DIABETES occurs more often in people over the age of 40, and many people with TYPE II DIABETES are overweight. Many also are not aware that they have the disease. Some people with TYPE II DIABETES control their blood sugar with diet and an exercise program leading to weight loss. Others must take pills that stimulate production of insulin; still others require injections of insulin.

TYPE I DIABETES

A less common form of diabetes, known as insulin-dependent diabetes or Type I diabetes, tends to occur in young adults and children. In cases of TYPE I DIABETES, the body produces little or no insulin. People with TYPE I DIABETES must receive daily insulin injections.

TYPE II DIABETES accounts for about 95 percent of all cases of diabetes; TYPE II DIABETES accounts for about 5 percent. Both types of diabetes can lead to kidney disease. TYPE I DIABETES is more likely to lead to ESRD. About 40 percent of people with TYPE I DIABETES develop severe kidney disease and ESRD by the age of SO. Some develop ESRD before the age of 30. TYPE II DIABETES causes 80 percent of the ESRD in African Americans and Native Americans.

The Course of Kidney Disease

The deterioration that characterizes kidney disease of diabetes takes place in and around the glomeruli, the blood-filtering units of the kidneys. Early in the disease, the filtering efficiency diminishes, and important proteins in the blood are lost to the urine. Medical professionals gauge the presence and extent of early kidney disease by measuring protein in the urine. Later in the disease, the kidneys lose their ability to remove waste products, such as creatinine and urea, from the blood.

Symptoms related to kidney failure usually occur only in late stages of the disease, when kidney function has diminished to less than 25 percent of normal capacity. For many years before that point, kidney disease of diabetes exists as a silent process.

Five Stages

Scientists have described five stages in the progression to ESRD in people with diabetes. They are as follows.

Stage I.

The flow of blood through the kidneys, and therefore through the glomeruli, increases this is called hyperfiltration and the kidneys are larger than normal Some people remain in stage I indefinitely; others advance to stage II after many years.

Stage II.

The rate of filtration remains elevated or at near normal levels, and the glonieruli begin to show damage. Small amounts of a blood protein known as albumin leak into the urine a condition known as microalbuminuria. In its earliest stages, microalbuminuria may come and go. But as the rate of albumin loss increases from 20 to 200 micrograms per minute, microalbuminuria becomes more constant (Normal losses of albumin are less than 5 micrograms per minute.) A special test is required to detect microalbuminuria. People with TYPE II DIABETES and TYPE I DIABETES may remain in stage II for many years, especially if they have normal blood pressure and good control of their blood sugar levels.

Stage III

The loss of albumin and other proteins in the urine exceeds 200 micrograms per minute. It now can be detected during routine urine tests. Because such tests often involve dipping indicator strips into the urine, they are referred to as “dipstick methods.” Stage III sometimes is referred to as “dipstick-positive proteinuria” (or “clinical albuminuria” or “oven diabetic nephropathy”). Some patients develop high blood pressure. The glomeruli suffer increased damage. The kidneys progressively lose the ability to filter waste, and blood levels of creatinine and urea-nitrogen rise People with TYPE I DIABETES and TYPE II DIABETES may remain at stage III for many years.

Stage IV

This is referred to as “advanced clinical nephropathy.” The glomerular filtration rate decreases to less than 75 milliliters per minute, large amounts of protein pass into the urine, and high blood pressure almost always occurs. Levels of creatinine and urea-nitrogen in the blood rise further.

Stage V

The final stage is ESRD. The glomerular filtration rate drops to less than 10 milliliters per minute. Symptoms of kidney failure occur.

These stages describe the progression of kidney disease for most people with TYPE I DIABETES who develop ESRD. For people with TYPE I DIABETES, the average length of time required to progress from onset of kidney disease to stage IV is 17 years. The average length of time to progress to ESRD is 23 years. Progression to ESRD may occur more rapidly (5-10 years) in people with untreated high blood pressure. If proteinuria does not develop within 25 years, the risk of developing advanced kidney disease begins to decrease. Advancement to stages IV and V occurs less frequently in people with TYPE II DIABETES than in people with TYPE I DIABETES. Nevertheless, about 60 percent of people with diabetes who develop ESRD have TYPE II DIABETES.

Effects of High Blood Pressure

High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease where it already exists.

Hypertension usually is defined as blood pressure exceeding 140 millimeters of mercury-systolic and 90 millimeters of mercury-diastolic Professionals shorten the name of this limit to “140 over 90.” The terms systolic and diastolic refer to pressure in the arteries during contraction of the heart (systolic) and between heartbeats (diastolic).

Hypertension can be seen not only as a cause of kidney disease, but also as a result of damage created by the disease. As kidney disease proceeds, physical changes in the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure, occurs. Early detection and treatment of even mild hypertension are essential for people with diabetes.

Preventing and Slowing Kidney Disease

Blood Pressure Medicines

Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure (antihypertensive drugs) can slow the progression of kidney disease significantly. One drug, an angiotensin-converting enzyme (ACE) inhibitor, has proven effective in preventing progression to stages IV and V.1 Calcium channel blockers, another class of antihypertensive drugs, also show promise.

An example of an effective ACE inhibitor is captopril, which the Food and Drug Administration approved for treating kidney disease of Type I diabetes. The benefits of captopril extend beyond its ability to lower blood pressure; it may directly protect the kidney’s glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in diabetic patients who did not have high blood pressure.

Some, but not all, calcium channel blockers may be able to decrease proteinuria and damage to kidney tissue. Researchers are investigating whether combinations of calcium channel blockers and ACE inhibitors might be more effective than either treatment used alone. Patients with even mild hypertension or persistent microalbuminuria should consult a physician about the use of antihypertensive medicines.

Low-Protein Diets

A diet containing reduced amounts of protein may benefit people with kidney disease of diabetes. In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that most patients with stage 111 or stage IV nephropathy consume moderate amounts of protein.

Intensive Management

Antihypertensive drugs and low-protein diets can slow kidney disease when significant nephropathy is present, as in stages 111 and IV. A third treatment, known as intensive management or glycemic control, has shown great promise for people with TYPE I DIABETES, especially for those with early stages of nephropathy.

Intensive management is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes frequently testing blood sugar, administering insulin on the basis of food intake and exercise following a diet and exercise plan, and frequently consulting a health care team.

A number of studies have pointed to the beneficial effects of intensive management. Two such studies, funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, are the Diabetes Control and Complications Trial (DCCT) 2 and a trial led by researchers at the University of Minnesota Medical School 3

The DCCT, conducted from 1983 to 1993, involved 1,441 participants who had TYPE I DIABETES Researchers found a 50% decrease in both development and progression of early diabetic kidney disease (stages I and II) in participants who followed an intensive regimen for controlling blood sugar levels. The intensively managed patients had average blood sugar levels of 150 milligrams per deciliter about 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients.

In the Minnesota Medical School trial, researchers examined kidney tissues of long-term diabetics who received healthy kidney transplants. After 5 years, patients who followed an intensive regimen developed significantly fewer lesions in their glomeruli than did patients not following an intensive regimen. This result, along with findings of the DCCT and studies performed in Scandinavia, suggests that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of diabetic nephropathy.

Dialysis and Transplantation

When people with diabetes reach ESRD, they must undergo either dialysis or a kidney transplant. As recently as the 1970’s, medical experts commonly excluded people with diabetes from dialysis and transplantation, in part because the experts felt damage caused by diabetes would offset benefits of the treatments. Today, because of better control of diabetes and improved rates of survival following treatment, doctors do not hesitate to offer dialysis and kidney transplantation to people with diabetes.

Currently, the survival of kidneys transplanted into diabetes patients is about the same as survival of transplants in people without diabetes. Dialysis for people with diabetes also works well in the short run. Even so, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of the diabetes such as damage to the heart, eyes, and nerves.

Good Care Makes a Difference

If you have diabetes:

· Ask your doctor about the DCCT and how its results might help you.

· Have your doctor measure your glycohemoglobin regularly. The HbA1c test averages your level of blood sugar for the previous 1-3 months.

· Follow your doctor’s advice regarding insulin injections, medicines, diet, exercise, and monitoring your blood sugar.

· Have your blood pressure checked several times a year If blood pressure is high, follow your doctor’s plan for keeping it near normal levels.

· Ask your doctor whether you might benefit from receiving an ACE inhibitor

· Have your urine checked yearly for microalbumin and protein. If there is protein in your urine, have your blood checked for elevated amounts of waste products such as creatinine.

· Ask your doctor whether you should reduce the amount of protein in your diet.

Diabetes Prevention Program

Could you get diabetes?

· Does someone in your family have diabetes?

· Are you overweight?

· Did you get diabetes when you were pregnant?

If you answered “yes” to any of these questions, you could get diabetes.

Join the Diabetes Prevention Program and help find out if diabetes can be prevented.

What is the Diabetes Prevention Program?

The Diabetes Prevention Program (DPP) is a research study looking at ways people like you can avoid getting diabetes.

Right now there is no cure for diabetes. But doctors believe that diabetes may be avoided by eating healthy food, exercising more, or taking pills. We are looking for volunteers to help find out if this is true.

Who can join?

Men and women age 25 or older who are likely to get diabetes.

What will I be asked to do?

If you join the study, you may be asked to:

· Exercise and eat healthy food.

· Visit our medical center on a regular basis over three to six years to have your blood sugar level, weight and blood pressure checked.

How may I benefit?

· You will receive free physical exams.

· A team of caring doctors and nurses will see you regularly to help you stay in good health throughout the study.

· You may be able to avoid getting diabetes.

· You may help your family in the future by contributing to medical research.

What is diabetes?

Diabetes causes too much sugar in the blood. It can lead to blindness, amputations, kidney failure and heart attacks. Diabetes affects people of all backgrounds, but is more common in overweight and older people.

How can I join?

To join the DPP, please contact the following: